Non-Small Cell Lung Cancer - Chemotherapy Treatments

Combinations of Chemotherapy with Surgery, Radiation, or Both

Chemotherapy Following Surgery (Adjuvant Chemotherapy). Chemotherapy is being evaluated in combination with surgery, radiotherapy, or both. Fairly strong evidence is now supporting the use of platinum-based chemotherapy as adjuvant treatment after surgery in patients with lung cancers in stages Ib-IIIa, with some research indicating a 5% improvement in five-year survival rates. Not all studies confirm survival benefits, however, and trials are ongoing.

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Chemotherapy before Surgery (Induction Chemotherapy). Some researchers are testing induction chemotherapy, which is used to shrink potentially operable tumors before surgery. Studies have been mixed in reporting any benefits in survival in patients with in advanced lung cancer.

Combined and Multi-Modal Therapy. In stage III cancers, investigators are researching very intensive treatments that use two or more combinations of chemotherapy, radiation, and surgery.

For example, radiation plus chemotherapy may be helpful in patients whose tumors are surgically removable.

In inoperable lung cancer, combining radiation with chemotherapy is proving to prolong the time to recurrence, overall survival duration, or both compared to radiation alone. Evidence is further suggesting that giving radiation concurrent with chemotherapy improves five-year survival rates compared to a sequential approach. Concurrent treatment is more toxic.

Other approaches use even more intensive multi-modal therapy. For example, some trials employ radiotherapy concurrent with chemotherapy followed by surgery. Patients are then sometimes given additional chemotherapy or radiation. In other promising regimens, patents are given concurrent radiation and chemotherapy followed by chemotherapy alone. Such approaches are very toxic but appear to improve survival in selected patients.

Toxicities are high, however, with a combination of radiation and chemotherapy. Severe inflammation in the esophagus is the most common severe side effect of this regimen. There is also a very high risk of serious infections, including pneumonia, herpes zoster, and cytomegalovirus, and long-term antibiotic therapy may be needed. Of note, although patients over 70 may suffer more from toxic effects than younger patients, a 2003 study suggested that they can achieve survival rates with combined treatments that are equal to those in younger patients.

Agents Used for Pain Relief

There are many painkilling medications available. Research has demonstrated that aggressive pain relief can help patients better manage cancer treatment symptoms other than pain. For example, a 2001 study suggested that reducing pain in elderly cancer patients markedly lowered their fatigue levels, and other symptoms as well.

Opioids are the most potent pain killers. Proper use of these strong medications is very important for achieving acceptable pain relief and preventing a toxic response. For instance, the long-lasting version of oxycodone (OxyContin) must be swallowed whole; chewing, inhaling, or injecting it can create a lethal overdose.

Drugs known as bisphosphonates, particularly zoledronic acid (Zometa), are proving to be useful in preventing complications from cancers that have metastasized to bones. The drug, in fact, may help reduce metastasis to the bone.